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X-Ell Employee Benefits, LLC |
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1680 Route 23 North, Suite 310, Wayne, NJ 07470 |
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Standardization |
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NJ Small Employer (2-50) Reform Law Summary |
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STANDARDIZED
PLANS: All new plans offered to small
employers in the state of New Jersey after January, 1994, must be filed and
approved by the State to assure compliance with the plan designs allowed by
law. The plan designs refer to the
products: benefit payment levels, out-of-pocket costs, delivery systems, and
standard features. A standardized plan that
conforms to the Reform laws is known as a "mandated" plan. Mandated plans are homogenous between
carriers so consumers can accurately assess the competitive differences
between insurance companies.
Therefore, a small employer can count on the fact that every carrier
serving small employers will offer at least the basic sate mandated plans
that will be considered, for the most part, identical products. All mandated plans are
comprehensive, meaning that they provide benefits for physicians services,
hospital services, and major medical. STANDARDIZED
BENEFITS: Each of the mandated plans will
offer the same minimum benefits as defined by State law. Carriers may opt to offer richer benefits,
but the basic coverage must not be diminished in any way. Plan limitations and exclusions
are regulated by the State and are also the same for all competing carriers. Well/routine care benefits were
incorporated as a basic benefit under all the plans. In addition to
hospitalization, standard coverage was also provided for: therapy services,
home health care, hospice care, maternity, alcohol/substance abuse, mental
care, prescription drugs, labs and radiology, hospital care, physicians
services, chiropractic care, and many other services. Many recent mandates have added
standard coverage for a number of different diseases. STANDARDIZED
FORMS: Under Reform, the State mandates
that all forms required to enroll a small employer for health benefits
coverage be the same for each carrier.
Though the actual contents of the forms are generic, a carrier has the
liberty to customize the layout and design to incorporate logos and special
page formats. The intent of standardization of
paperwork was to eliminate confusion for the employer and employees enrolling
for health benefits. |
